MDE HIS 2007-1

1. Male, 14 y.o : joint bleeding. Ada history bleeding. Hemarthrosis. Hb 14gr/dL. WBC 8000. PLT 225.000. How can you explain this problem?
A. quantitative PLT disorder
B. qualitative PLT disorder
C. coagulation disorder
D. thrombotic disorder
E. vascular disorder
Jawaban : C
Alasan : karakteristik coagulation disorder : hemarthrosis dan hematoma. A, B, E  primary hemostasis disorder  PLT ↓qualitative & ↑quantitative, vasculat defect. (Harmening hlm 471-472)

2. Lab test apa untuk konfirmasi diagnosis?

3. Diagnosis?
A. ITP
B. henoch S purpura
C. von Willebrand disease
D. DIC
E. Acute leukemia
Jawaban : C
Alasan : kelainan koagulasi dengan SS di atas paling mungkin vWF disease

4. Character of cell in IDA?
Jawaban : hypochromic, microcytic RBC

5. Abnormalities PLT di atas disebabkan oleh?
Jawaban : ITP

6. Most appropriate statement of the case?
A. mostly will have spontaneous remission
B. mostly will need splenectomy
C. mostly will need IV Ig
D. about half respond to corticosteroid
E. about half will change to leukemia
Jawaban : D
Alasan : Patients with ITP are initially treated with corticosteroid to rapidly increase PLT and improve hemostasis (Harmening hlm 475)

7. Cells that will increase in bone marrw smear as a compensation in this case?
A. thrombocyte
B. reticulocyte
C. magakaryocyte
D. myeloblast
E. normoblast
Jawaban : C
Alasan : jumlah PLT ↓  dikompensasi dengan bentuk dan ukuran yang besar dikarenakan pembentukan yang belum sempurna

8. In primary hemostasis, what mediates the PLT adhesion to expose collagen within the endothelium of the vessel wall?
A. GpIb
B. fibrinogen
C. plasmin
D. PDGF
E. kinin
Jawaban : A
Alasan : Harmening bab introduction to hemostasis

50 y.o. male, bilateral painless mass in the neck, fever, night sweat, weight loss (60-50). PE : bilateral subclavicular and cervical lymphadenopathy diameter 1-3, rubbery, non-tender, hepatosplenomegaly (-)
9. Which is the cause of lymphadenopathy?
A. Inflammation
B. Infection
C. Metastasis malignancy
D. Lymph node
E. Autoimmune
Jawaban : C
Alasan : ada mass, fever, night sweat, weight loss  kemungkinan besar ada keganasan

10. The most appropriate exam :
A. lymph node biopsy
B. Abdomen USG
C. LDH
D. Bone marrow aspiration
E. PBS
Jawaban : A
Alasan : untuk memeriksa jenis jaringan lymph yang terkena diperlukan biopsy

11. Clinical stage :
A. IA
B. IB
C. IIA
D. IIB
E. IIIA
Jawaban : D
Alasan : dengan ciri2 di atas kemungkinan kasus yang terjadi adalah hodgkin lymphoma. Klasifikasi :
• Stage I is involvement of a single lymph node region (I) or single extralymphatic site (Ie);
• Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe);
• Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes);
• Stage IV is disseminated involvement of one or more extralymphatic organs
The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage. For localized extranodal extension from mass of nodes that does not advance the stage, subscript 'E' is added.

12. Which is the most appropriate source of the most cause of lymph adenopathy?
A. Head
B. Oral cavity
C. Thorax
D. Inguinal
E. Inferior extremity
Jawaban : A
Alasan : Cervical adenopathy is a common feature of many viral/bacterial infections

13. What is the positive factor to determine prognosis?
A. Liver enzyme level
B. Creatine level
C. LDH level
D. Uric acid level
E. Hb level
Jawaban :
Alasan : The adverse prognostic factors identified in the international study are:
• Age >= 45 years
• Stage IV disease
• Hemoglobin < 10.5 g/dl
• Lymphocyte count < 600/µl or < 8%
• Male
• Albumin < 4.0 g/dl
• White blood count >= 15,000/µl

Female, 33 y.o. fatigue, shortness of breath with exercise, heavy menstrual bleeding for several years, increase TIBC, decrease ferritin and transferrin
14. Diagnosis?
A. Thalassemia
B. Acquired hemolytic anemia
C. Pernicious anemia
D. Aplastic anemia
E. Iron deficinecy anemia
Jawaban : E
Alasan : karena ada increase TIBC, decrease ferritin and transferrin

15. What cell that will be difficult to found in bone marrow smear?
A. Basophilic normoblast
B. Polychromatophilic normoblast
C. Acidophilic normoblast
D. Reticulocyte
E. Pronormoblast
Jawaban : E?
Alasan : sebenernya jawabannya “lack of stainable iron in reticuloendothelial cells”, tapi ga ada di pilihan.

16. A 18 y.o. female acute onset of bruising & rash for 3 days, had...approx. 2 weeks ago, no fever, no history bleeding, no hepatomegaly. Diffuse petechial rash on trunk & extremities. Lab : Hb 11.5, Hct 36, WBC 6000, PLT 15.000/mm3, PT/PTT normal. Diagnosis?
A. Hemophilia
B. von Willebrand disease
C. ITP
D. Hemorrhagic disease for newborn
E. DIC
Jawaban : C
Alasan : PLT <30.000, ada petechiae (Harmening hlm 474)

17. A 5 y.o. male, RS akibat pneumococcal sepsis selama 3 hari, diffuse petechiae purpura, venipuncture bleeding, hypotension, adn shock. PLT and fibrinogen decrease. Characteristic :
A. ↑ PLT
B. ↑ plasma fibrinogen
C. ↑ factor VIII
D. ↑ tPA
E. ↑ D-dimer
Jawaban : E
Alasan : penurunan fibrinogen  menandakan banyak pemecahan fibrinogen  akan menghasilkan D-dimer (Harmening hlm 463)

18. a previous healthy baby  unconscious for the 3rd day of life. CT scan : intrasranial bleeding. Lab : HB 11, WBC 6000, PLT 117.500, PT dan aPTT ↑, BP normal.
A. ↓ PLT
B. ↓ fibrinogen
C. ↓ AHF
D. ↓ factor II, VII, IX, X
E. ↓ nature inhibitor of coagulation
Jawaban : D
Alasan : peningkatan PT  gangguan extrinsic/common pathway. Peningkatan aPTT  gangguan intrinsic/common pathway. Kemungkinan mengalami gangguan multifactor.

19. Diagnosis :
A. Hemophilia
B. DIC
C. Hemorrhagic disease in newborn
D. congenital hypofibrinogenemia
E. von Willebrand disease
Jawaban : C
Alasan : gangguan koagulasi akibat kurangnya vit K untuk pembentukan faktor koagulasi (Wintrobe ch )60

20. Vitamin yang dibutuhkan?
A. Vit A
B. Vit B
C. Vit K
Jawaban : C
Alasan : vit K merupakan vit yang dibutuhkan untuk pembentukan faktor koagulasi.
21.C. dibuktikan dengan adanya low Hb, HCT, MCV,MCH, dan retikulosit tanpa adanya tanda2 hemolitik anemia (hepatosplenomegaly, jaundice, increasing bilirubin). Pada anak kecil, salah satu penyebab dari Fe deficiency adalah malnutrisi atau infeksi parasit yang dibuktikan dengan adanya underweight..
22. Penampakan yang muncul apabila seseorang terkena IDA yaitu
Peripheral blood smear : microcytic,hypochrome, aniso-poikilocytosis, terdapat pencil shape, juga terdapat target cell
Bone marrow smear : mild-moderate erythrocytosis, decrease-depleted dari sideroblastic cells appearance, bahkan bisa sampai nuclear distortion, nuclear budding, karyohexis, dan nuclear fragmentation of normoblastic cells
23. ans: aplastic: dengan adanya tanda2 pancytopenia di bone marrow dan peripheral : anemia (fatigue, pallor, RBC count rendah), leukocytopenia (rentan terjadi infeksi => fever), thrombocytopenia (petechiae, ecchymoses, gum bleeding).
24. ans: E. hemophilia A karena depleted dari factor VIIc, oleh karena itu, treatment yang tepat ialah cryoprecipitate (mengandung factor VIIIc, VIIIag, fibrinogen, dan XIII) atau purified factor VIII.
25.?? Ga ngerti.. sorii
26. A. pendarahan  hypovolemic condition.. berdasarkan wintrobe pada bab transfusion medicine, keadaan hypovolemic ditangani dengan transfuse whole blood.
27. A. yang menjadi key wordnya adalah deep blue scanty dengan no granule yang merupakan cirri dari normoblastic cell.. jika dilihat dari option yang berwarna biru itu pronormoblast dan normoblast basophilic.. tapi warna dari pronormoblast adalah dark/royal blue, sedangkan warna normoblast basophil adalah basophil, lebih terang dari pronormoblast.
28.?
29. selama acute inflammation : CBC, CRP / ESR.
30.A. gambarannya ialah MCV rendah = microcytic, MCHC rendah = hypochrome.
31.B. gambarannya mengarah Fe deficiency.
-Megalloblastic = MCV biasanya naik
-Hemolytic anemia = MCV,MCH turun, MCHC turun(hereditary spherocytocyte naik) tapi ada peningkatan dari RBC dan reticulocyte count serta ada tanda2 seperti jaundice,splenomegaly
-Aplastic = jumlah WBC dan platelet juga turun
-Pernicious anemia = gambaran megalloblastic.
32. B. liat penjelasan no 22
33. C. adanya peningkatan yang besar dari blast cell golongan myeloid. Jadi jelas merupakan AML.
34. seharusnya sih tipe FAB M3, karena ditandai dengan adanya abundant auer rod di leukemic cells (faggot cells) dan adanya tanda hemorrhagic manifestation dari DIC.
35.A. adanya tanda2 anemia : pale dan hb turun, increasing destruction dari RBC berupa splenomegaly, dan adanya kompensasi anemia, yaitu peningkatan retikulosit  kecurigaan hemolytic anemia (kalo deficient B12, tanda2nya bisa kaya di atas tapi retikulositnya turun). Lalu gambaran anisopoikylocytosis, polychromasia, large target cell merupakan gambaran yang bisa terjadi pada sickle cell anemia dan thlasemia (sickle cell trait punya gambaran yang normal di apus darah tepi). Lalu pasien kita ini sudah berumur 5 tahun, padahal thalasemia itu termanifest pada 1st year of life. Jadi jawaban adalah A.
36. soalnya seperti tadi. ANS: A. untuk mendiagnosis dari sickle cell, lab exam selanjutnya ialah electrophoresis. Hasil yang diharapkan adalah adanya peningkatan dari HbS sehingga hasil electrophoresisnya terhadap HbS men jadi lebih nyata.
37. A. jelas ya..
38.A. pilihan treatment untuk sickle cell anemia ialah chronic transfusion, hydroxyurea, dan bone marrow transplantation. Yang ditransfusi untuk kasus sickle cell anemia adalah normal red cell. Jadi pilihan ke arah packed red cell (PRC)
39.C.
40. ??
41. Jawaban : D. decrease serum ferritin
Pembahasan :
Merupakan ciri-ciri Iron Deficiency Anemia (IDA).
Hasil lab : decrease serum ferritin level, derease serum iron level, increase TIBC (Harmening, 104)

42. Jawaban : C. vitamin C
Pembahasan :
Menurut internet, vitamin C memang membantu absorbsi non-heme iron.

43. Jawaban : A. vitamin B12
Pembahasan :
Clinical manifestation of vit.B deficiency:
-peripheral nerve : paresthesia, areflexia, symmetric tingling.
-posterior spinal columns : clumsiness, incoordinate gait.
-lateral spinal columns : weakness & stiffness of limbs, memory impairment, depression.
(Harmening, 119)

44. Jawaban : (?) akademik 2006 jawab D. gum hypertrophy
Pembahasan :
“Classic symptoms of vit B12 deficiency include weakness, glossitis, paresthesia.” (Harmening, 118)

45. Jawaban : B hemolytic
Pembahasan :
Subiteric sclera -> banyak bilirubin di darah -> banyak pemecahan RBC (hemolytic) -> splenomegaly (kerja berat, tempat pemecahan RBC)

46. Jawaban : E. glossitis
Pembahasan :
Merupakan penyakit anemia megaloblastik, karena ada ciri-ciri weakness, numbness, hypersegmented neutrophil (Harmening115,119). Maka PE-nya kemungkinan terdapat glossitis (Harmening, 118)

47. Jawaban : E. hyperativity of macrophage cell
Pembahasan :
Penyakitnya anemia hemolitik, karena yellow skin.
“Each day 1% of old RBC in circulation are taken out by a system of fixed macrophages in the body known as the reticuloendothelial system (RES). Although RES cells are located in various organs and throughout te body, those of spleen, called littoral cells, are the most sensitive detectors of RBC abnormalities.” (Harmening, 70)

48. Jawaban : C. gaster
Pembahasan :
Penyakitnya anemia megaloblastik, karena ada giant stab/band cell (Harmening, tabel 7-1,115).
Kemungkinan penyebabnya berasal dari gaster. “Pernicious anemia = vit B12 deficiency anemia. Caused by deficiency of IF. IF is secreted by gastic parietal cell, and in this case there is parietal cell atrophy.” (Harmening, 117)

49. Jawaban : (?) akademik 2006 jawab A. Hodgkin lymphoma
Pembahasan :
Penyakit yang histopatologinya ada “rossete-like formation” = ?

50. Jawaban : B. chronic lymphocytic leukemia
Pembahasan :
WBC sangat meningkat -> keganasan.
Periphreal blood, mature lymphocyte meningkat -> chronic lymphocytic leukemia /CLL (Harmening, tabel 16-2, 275)

51. Jawaban : C. observe
Pembahasan :
Klasifikasi Rai-Binet untuk CLL (Harmening, tabel17-5, 310).
Pada kasus ada splenomegali, jadi masuk stage II. Treatmentnya observation, karena pada kasus ini asymptomatic (Harmening, tabel17-6, 311)

52. Jawaban : (?) akademik 2006 jawab A. B-prolymphoid transf well diff.
Pembahasan :
“CLL is most frequent neoplasm of B lymphocyte.” (Harmening, 302)
“Photomicrogaph of bone marrow aspirate smear from CLL patient. Note monotonous appearance of mature-appearing lymphocytes with condensed nuclear chromatin.” (Harmening, fig 17-2, 303)
A. pro- vs mature = ?

53-60. ga ada soalnya...


83.
84.
85. B. G6PD
Sulfamethoxazole has side effect that cause deficiency of glucose 6 phosphate. Deficiency of this enzyme can cause breakdown of RBC (hemolisys)
86. C. Normochromic normocytic
Hemolityc blood smear
87.
88. B. Type B child
89. D. Father Rr
90. C. Palatine tonsil
The lymphoid tissue in palatine tonsils forms a band that contains free lymphocytes and lymphoid nodules, generally with germinal centers . Deeply invaginated mucosal surface is the characteristic of these tonsil. Each tonsil has 10–20 epithelial invaginations that penetrate the tonsil deeply, forming crypts, whose lumens contain desquamated epithelial cells, live and dead lymphocytes, and bacteria. (jonquera,bab palatine tonsil)
95. E. 0,3 in 1:1000
Ephinephrine is injected intramuscularly or subcutaneously in dose 0,2-0,5 ml/kg BW for adults and 0,1 ml/kg BW for children to treatment treat anaphylaxis reaction.It is in aqueous 1:1000 solution.
96. B. irreversible shock
The most frequent cause of death in the case of anaphylaxis
97. D. IgG
IgG is the autoantibody of SLE so it can cross placenta
98. D. between 12-16 week of gestation
99. A. congenital heart block
100. A. infection
One of effext of steroid administration is immunosuppressant. It is increase the r isk of infection.

100) D
103) A
104) B
105) A
106)
107) A
108) hypersensitivity type 1
109) A
110) B
111)
112)
113)Ig E (+) = atopy
114) B
115) A
116)
117)
118) D (I think)
119) C
120) A
126. a girl 6 year old wheal with certain blanching after eating shrimp. Have allergy cold, no food allergy before. What skin layer appears abnormal ?
Ans.
D. Pars papillaris
127. a 25 years old man came to hospital with a sign of inflammation in his left leg. Which of the following vessels is most likely abnormal ?
Ans.
C. Capillary
128. a 20 years old IV drugs user came into the internal medicine department for general check up. Lab finding shows that he has HIV. Which is most likely cell killed by above virus ?
Ans.
C. CD4+ T lymphocyte
129. most likely characteristic above virus ?
Ans.
C. Have single stranded RNA
130. what gene is likely needed for replication for above virus ?
Ans.
B. Tat
133. following target cell will be killed by cytotoxic T cell induced by viral infection ?
Ans.
B. Infected by virus and identical at class I MHC loci of the cytotoxic T cell
134. after binding to its specific antigen, B lymphocytes may switch t which of the following component ?
Ans.
C. Variable region of the Ig heavy chain
135. which one of the following must be expressed on the surface of APC that activate T helper cells ?
Ans.
D. Class II MHC antigen
136. which of the following class of immunoglobulin is present in highest concentration in the blood of a newborn ?
Ans.
A. IgG
137. which of the following statement is the response of macrophage for antibody reaction ?
Ans.
A. Lysing virus infected cell
138. male 47 years old, chief complaint right toe swelling. In middle night : pricking, stiffness on his right toe. One hour later more painful. Few hours later swelling red and painful. He has tight hypertension, easy socializing with his friends. He is also overweight. Diagnosis ?
Ans.
A. Gouty arthritis
141. which of the following criteria include the ACR diagnostic criteria for her disease ?
Ans.
B. Increase ANA titer and positive anti dsDNA

For questions number 161 – 163, see the case below :
25-year-old woman, red, itchy, circumscribed patches with central blanching on her body, swollen lips, and itchy tongue after consumption of methampirone. BP 80/60. RR 24/min. Temperature 37.5°C. PR 130/min

161. Which of the following mediator most likely inhibiting the process causing the above condition ?
A. PGI2
B. PGE2
C. PGD2
D. PGF2
E. TXA2
Jawab : E
Hipersensitivitas tipe I. Gejala-gejalanya disebabkan oleh mediator-mediator yang menyebabkan vasodilatasi dan peningkatan permeabilitas vascular. Thromboxane (vasokonstriktor) dapat menyebabkan penghambatan.

162. What is the enzyme responsible ?
A. Adenylate cyclase
B. Guanylate cyclase
C. Thymidine cyclase
D. Uridine cyclase
E. Cystosine cyclase
?

163. Which mediator is inhibited on this phase ?
A. Histamine
B. Leukotriene
C. Prostaglandin
D. Prostacyclin
E. Thromboxane
Jawab : E

164. Chief complain : runny nose. He started sneezing after he cleaned books. Family history : sibling has urticaria. Father has rhinitis. What is the antibody responsible ?
A. IgG
B. IgA
C. IgE
D. IgM
E. IgD
Jawab : C
Allergic rhinitis  IgE-mediated 

165. Malar rash especially on photosensitivity area, caused by immune complex. What type of hypersensitivity responsible ?
A. I
B. II
C. III
D. IV
E. All above
Jawab : C
Kata kuncinya adalah “immune complex”, apalagi sign and symptom merujuk ke lupus. Jadi, hypersensitivity type III.

166. A 7-year-old girl suffered from multiple rashes on her face and symmetrical macule rashes on her feet and trunk. She also complained itchy redness and patches on her elbow and knee fold. Both parents have intermittent asthma, and her sister has unexplained urticaria. Which immunology abnormality that most commonly occurs ?
A. Decrease IgE
B. Decrease basophilic histamine release
C. Decrease IL-13 by TH1
D. Increase IFN gamma by TH-2
E. Increase soluble IL-2 receptor
Jawab : C
Diagnosisnya adalah psoriasis. Psoriasis adalah penyakit autoimmune yang dimediasi oleh T-cell. Di Robbins (hal. 1257) disebutkan, pada psoriasis, terdapat cytokine “soup” yang didominasi oleh TH1 cytokines seperti IL-12, IFN-γ, dan TNF-α. (catatan : TH2 cytokine : IL-4 dan IL-13). Seperti kita tahu, TH1 dan TH2 cytokine (maupun selnya) cenderung timpang dalam keadaan tertentu, misalnya jika keadaan hypersensitivity type I (e.g. allergic rhinitis), maka yg dominan adalah TH2 dengan konsekuensi supresi oleh TH1.
Maka karena pada psoriasis yang dominan adalah TH1, terjadi supresi TH2 cytokine (yakni IL-13).

See the case below :
9-year-old boy came to ophthalmology department whith a chief complain of itching, blepharospasm, photophobia, and copious mucoid discharge. Visual acuity is within normal limit. The slit examination revealed cobblestone in superior tarsal conjunctivae.

167. The most likely diagnosis is :
A. Vernal conjunctivitis
B. Atopic conjunctivitis
C. Acute conjunctivitis
D. Flictenuralis conjunctivitis
E. Follicle conjunctivitis
Jawab : A
Kata “cobblestone in superior tarsal conjunctivae” menunjukkan vernal conjunctivitis (Lange Immunology hal. 527).

168. Which type of hypersensitivity can cause this reaction :
A. Type I and II
B. Type I and III
C. Type I and IV
D. Type II and III
E. Type II and IV
Jawab : A
Di Lange (hal. 527) disebutkan vernal conjunctivitis adalah atopic disease, jadi termasuk tipe I. Selain itu, dia dikategorikan juga di bawah “antibody-mediated disease”, jadi masuk tipe II juga. Memang immunologic pathogenesisnya belum terlalu jelas.

169. A 40-year-old lady complained decrease of her vision since 3 days ago. She was also diagnosed as TB patient. On clinical exam, there is ciliary injection, anterior chamber …, keratic precipitate. What is the most likely diagnosis ?
A. Acute uveitis
B. Vitritis
C. Choroiditis
D. Endophthalmitis
E. Pars planitis
Jawab : A
Uveitis dikarakteristikkan dengan adanya keratotic precipitate (berupa WBC) pada endothelium. Selain itu, ada ciliary injection (tapi tidak spesifik untuk uveitis).

170. The drug for acute uveitis ?
Cycloplegics (block nerve impulse to ciliary muscles, therefore easing pain) dan topical steroid.

171. 50-year-old man, red, and painful eyes with excessive tears. Examination results : peripheral corneal ulcer, negative fluorescence. What is the most likely diagnosis ?
A. Bacterial ulcer
B. Herpetic ulcer
C. Geographian ulcer
D. Fungal ulcer
E. Maroon ulcer
?

See the case below :
A 20-year-old man. Weakness  worst and numbness. 10 days ago, he had fever, diarrhea, and was healed by treatment. PE : dyspnea. Neurologic exam : tetraparesis, glove-stocking hypesthesia and decreased physiological reflex.

172. What is the finding in blood ?
A. Increase glucose with normal protein
B. Increase glucose with normal cell
C. Increase glucose with normal glucose
?

173. What microbe can cause this case ?
A. H. influenza
B. Campylobacter jejuni
C. Cytomegalovirus
D. S. typhii
E. Herpes zoster
Jawab : B
Guillain-Barre Syndrome bisa disebabkan Campylobacter jejuni, HIV, EBV, cytomegalovirus. Tapi karena didahului gastrointestinal infection (diare yang disembuhkan dengan treatment), maka B lebih tepat.

174. What is the possible cause of dyspnea ?
A. Ascending paralysis
B. Metabolic acidosis
C. Pulmonary distress
D. Laryngeal spasm
E. Metabolic alkalosis
Jawab : A
Guillain-Barre Syndrome dikarakteristikkan dengan adanya ascending paralysis dari ekstremitas bagian distal. Salah satu komplikasinya adalah respiratory failure.

175. Neurophysiological examination as an additional for this case :
A. EEG
B. EMG
C. NCS
D. Evoked potential
E. TCD
Jawab : NCS atau EMG
Di fase awal, NCS (nerve conduction studies) akan menunjukkan adanya prolonged distal motor latencies dan prolonged/absent F waves. Setelah 4-6 minggu, EMG menunjukkan adanya denervasi otot.

176. Drugs of choice for this case :
A. Corticosteroid
B. Immunoglobulin
C. Plasmapharesis
D. Neurotrophic
E. Neuroprotected
Jawab : B
Treatmentnya berupa plasmapharesis dan immunoglobulin IV. Karena pertanyaannya “drugs” of choice, jadi jawabnya B.

177. –
178. –
179. –
180. –

182.D.Intraepidermal blister with acantholitic cell

Alasan: Microscopic pada pemphigus vulgaris ialah: an intraepidermal blister is present containing acantholytic cells.There is marked intracellular edema and eosinophilic spongiosis.

189.C.Decrease cAMP dependent protein kinase

Alasan: dengan penurunan cAMP dependent protein kinase akan mengakibatkan peningkatan cAMP yang akan menghambat degranulasi.

190.A.preventing rather than reversing histamin’s action on target tissue

Alasan: MOA of anti-histamin in prevent effect H1 receptor activation through reversible, competitive inhibition of histamine by binding to H1-receptor.As a result,antihistamin work best in preventing rather than reversing the action of histamine.

192.C.Scofferin

193.E.Agglutination and immobilizing spermatozoa

Alasan: ASA (Anti Spermatozoa Antibody) akan attract to sperm yang mengkibatkan reducing mortality dan make clump together so difficult form sperm to fertilize an egg.

194.A.Object of transplatation

Alasan: The succes of an organ or tissue transplant depends on histocompability-that is, the tissue compability between the donor and the recipient.

195.E.Loratadine

Alasan: dari keseluruh obsi hanya loratadine yang termasuk second generation (yang lain termasuk first generation) dimana second genertaion lebih baik daripada first generation karena tidak mengakibatkan CNS side effect.

197.B.NSAID

Alasan: pada treatment RA, NSAID merupakan first line treatment sedangkan cytotoxic agent seperti MTX dan cyclophosphamide dan corticosteroid merupakan second line.

198.C.Topical Antihistamin

Alasan: Pada pasein ini mengalami hypersensitivity type I sehingga treatment paling cocok ialah permberian anti-histamin

199.B.IgA

Alasan: IgA merupakan antibody yang banyak dijumpai di cairan tubuh (secret) seperti air liur, keringat, air mata, vaginal secret dsb

200.D.Polyclonal antibody generated by repeated rejection of human tymocyte into animals